Internet-delivered emotion regulation therapy for adolescents engaging in non-suicidal self-injury and their parents: A qualitative, online focus group study.

OBJECTIVES: We explore adolescents' and their parents' experiences of internet-based emotion regulation therapy for non-suicidal self-injury (NSSI). DESIGN: A qualitative study nested within a controlled feasibility trial. METHODS: Online, semi-structured focus group interviews were conducted with outpatient adolescents with NSSI aged 13-17 years (n = 9) and their parents (n = 8) who had received therapist-guided Internet-delivered Emotion Regulation Individual Therapy for Adolescents (IERITA). Transcripts were analysed using reflexive thematic analysis. RESULTS: Three main themes were generated: (1) Fatigue - barriers to and during treatment, comprised of two sub-themes 'Arriving to services exhausted, needing motivation, and leaving feeling abandoned' and 'the burden of IERITA and the consequences of fatigue', (2) inter- and intrapersonal insights as facilitators of change and (3) Online, written contact with the therapist is beneficial and contributes with less pressure, comprised of three sub-themes 'the therapist behind the screen is essential', 'less pressure sitting alone: the physical absence of a therapist' and 'engaging on your own terms, in your own tempo'. Themes were consistent among adolescents and parents. CONCLUSION: Fatigue due to therapeutic engagement and previous help-seeking processes created barriers for engagement. Emotion regulation therapy was experienced as beneficial leading to inter- and intra-personal insights, facilitating change of maladaptive patterns. Therapists were regarded as indispensable, and the internet-based format did not hinder therapeutic alliance. The written format allowed for reflection and alleviated the pressure of relating to the therapist. Further research should explore experiences of other online treatment formats (e.g. synchronous or video-based) with regard to benefits, fatigue and therapist interaction.

A Self-Applied Psychological Treatment for Gambling-Related Problems via The Internet: A Pilot, Feasibility Study.

The main purpose of this study was to evaluate the feasibility of an online psychological intervention for individuals with gambling-related problems, supported by ecological momentary assessments and interventions (EMAs and EMIs), along with weekly phone-calls, before conducting a randomized controlled trial. Participants were required to complete 3 of the 8 modules of the program based on cognitive-behavioral therapy (CBT) and extensions and innovations of CBT. The study measured the outcomes of feasibility (i.e., reach, appropriateness, technology literacy and technology usability, fidelity, and adherence). In terms of reach, 19.8% (n = 11) of the initial population met the inclusion criteria and completed the three modules (mean age = 41; 90.9% men). The perceived appropriateness and the technology usability after the first use were both excellent, fidelity and adherence to the online treatment (73.3%) were adequate. Adherence to the EMAs and the weekly phone calls were more modest (54.51% and 66.67%, respectively). The results of the present study show that an online treatment for gambling problems enhanced by EMA and EMI might be feasible but challenges were noted in terms of reach and adherence to these assessments and calls. These challenges are important to consider for future trials and the scalability of treatments for individuals with gambling disorders.

Evaluating the Feasibility, Acceptance, and Beneficial Effects of Online Occupational Therapy for Post-COVID-19 Condition: Protocol for a Randomized Controlled Trial (ErgoLoCo Study).

BACKGROUND: Post-COVID-19 syndrome (PCS; also known as "long COVID") is a relatively novel disease comprising physical, psychological, and cognitive complaints persisting several weeks to months after acute infection with SARS-CoV-2. Approximately 10% of patients with COVID-19 are affected by long-term symptoms. However, effective treatment strategies are lacking. The ErgoLoCo (Occupational Therapy [Ergotherapie] for Long COVID) study was designed to develop and evaluate a novel occupational therapy (OT) concept of online delivery of therapy for long COVID. OBJECTIVE: The primary study objective is to assess the feasibility of the online OT intervention in PCS. Secondary aims include the evaluation of online OT concerning cognitive problems, occupational performance, and social participation. METHODS: This randomized controlled interventional pilot study involves parallel mixed methods process analyses and a realist evaluation approach. A total of 80 clients with PCS aged at least 16 years will be recruited into two interventional groups. The control cohort (watch and wait) comprises 80 clients with long COVID. Treatment is provided through teletherapy (n=40) or delivery of prerecorded videos (n=40) using the same standardized OT concept twice weekly over 12 weeks. Analyses of quantitative questionnaires and qualitative interviews based on the theoretical framework of acceptability will be performed to assess feasibility. Focus group meetings will be used to assess how acceptable and helpful the intervention was to the participating occupational therapists. Standardized tests will be used to assess the initial efficacy of the intervention on neurocognitive performance; limitations in mobility, self-care, and everyday activities; pain; disabilities; quality of life (QoL); social participation; and anxiety and depression in PCS, and the possible effects of online OT on these complaints. RESULTS: The German Ministry of Education and Research provided funding for this research in March 2022. Data collection took place from October 2022 to August 31, 2023. Data analysis will be completed by the end of April 2024. We anticipate publishing the results in the fall of 2024. CONCLUSIONS: Despite the enormous clinical need, effective and scalable treatment options for OT clients who have PCS remain scarce. The ErgoLoCo study will assess whether online-delivered OT is a feasible treatment approach in PCS. Furthermore, this study will assess the effect of the intervention on cognitive symptoms, QoL, and occupational performance and participation in everyday life. Particular emphasis will be placed on the experiences of clients and occupational therapists with digitally delivered OT. This study will pave the way for novel and effective treatment strategies in PCS. TRIAL REGISTRATION: German Clinical Trial Registry DRKS00029990; https://drks.de/search/de/trial/DRKS00029990. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/50230.

A reference-point-method-based online proton treatment plan re-optimization strategy and a novel solution to planning constraint infeasibility problem.

Objective. Propose a highly automated treatment plan re-optimization strategy suitable for online adaptive proton therapy. The strategy includes a rapid re-optimization method that generates quality replans and a novel solution that efficiently addresses the planning constraint infeasibility issue that can significantly prolong the re-optimization process.Approach. We propose a systematic reference point method (RPM) model that minimizes the l-infinity norm from the initial treatment plan in the daily objective space for online re-optimization. This model minimizes the largest objective value deviation among the objectives of the daily replan from their reference values, leading to a daily replan similar to the initial plan. Whether a set of planning constraints is feasible with respect to the daily anatomy cannot be known before solving the corresponding optimization problem. The conventional trial-and-error-based relaxation process can cost a significant amount of time. To that end, we propose an optimization problem that first estimates the magnitude of daily violation of each planning constraint. Guided by the violation magnitude and clinical importance of the constraints, the constraints are then iteratively converted into objectives based on their priority until the infeasibility issue is solved.Main results.The proposed RPM-based strategy generated replans similar to the offline manual replans within the online time requirement for six head and neck and four breast patients. The average targetD95and relevant organ at risk sparing parameter differences between the RPM replans and clinical offline replans were -0.23, -1.62 Gy for head and neck cases and 0.29, -0.39 Gy for breast cases. The proposed constraint relaxation solution made the RPM problem feasible after one round of relaxation for all four patients who encountered the infeasibility issue.Significance. We proposed a novel RPM-based re-optimization strategy and demonstrated its effectiveness on complex cases, regardless of whether constraint infeasibility is encountered.

Symptoms and functional impairments in patients with Internet Use Disorders participating in an online short-term therapy.

BACKGROUND: Internet use disorders (IUD) have been recognized as a serious mental health concern. In order to promote consensus on core features of IUD, further studies involving clinical samples are required. AIMS: A clinical evaluation of patients with IUD was conducted as part of the scientific monitoring of a novel online short-term therapy, embedded in the randomized controlled trial Stepped Care Approach for Problematic Internet use Treatment (SCAPIT; ID: DRKS00025994). METHODS: An online diagnostic and a clinical assessment were performed at the baseline measurement of the online intervention. The self-report version of the Assessment of Internet and Computer Game Addiction (AICA-S) was applied to assess symptom severity of IUD. The impact of psychopathological symptoms and impairments of functioning on IUD symptomatology was examined in the sample of patients. Based on a dichotomous classification of the symptom severity of IUD, differences among participants presenting moderate compared to severe addictive Internet behavior were analyzed. RESULTS: The sample of this an analysis consisted of 57 patients (57.9% males, mean age of 29.12 years) participating in the online short-term therapy for IUD. Based on the AICA-S sum score (M = 11.60; SD = 3.30) participants exhibited moderate (n = 44; 77.2%) to severe (n = 13; 22.8%) symptoms of addictive Internet use. Psychopathological symptoms and impairments of psychosocial functioning had an effect on symptom severity of IUD. Participants with severe symptoms of IUD showed higher psychopathological strains compared to patients with moderate addictive Internet behavior. CONCLUSIONS: The clinical evaluation of patients participating in a novel online short-term therapy for IUD indicated that psychopathological symptoms and impairments of functioning have an impact on addictive Internet behaviors and consequently, need to be addressed in the treatment of IUD. Based on the results, further implications for clinical practice and research on addictive Internet behavior are derived.

Quando olhaste bem nos olhos meus, e o teu olhar era de adeus / When you looked right into my eyes, with a farewell gaze / Cuando me miraste directamente a los ojos, y tu mirada fue de adiós / Quand tu m'as bien regardé dans les yeux, et tu avais un regard d'adieu

A experiência coletiva diante do horror da finitude, reapresentada na pandemia atual, impôs o isolamento social e a mudança nas práticas clínicas. Com isso, a clínica psicanalítica enfrenta o desafio da reinstalação dos canais de comunicação psíquica dentro de um novo setting, virtual. Este artigo descreve as particularidades do atendimento online de um paciente melancólico em risco de suicídio, caso ficcionalizado para fins de discrição. O objetivo é mostrar, sob a luz das ideias de Freud em "Luto e melancolia" e de Sándor Ferenczi sobre o manejo da transferência, a possibilidade de transformação da dor psíquica em uma experiência estruturante a partir da migração das imagens para o campo da palavra.

The current pandemic has forced people to face the horror of finitude, imposed social isolation, and required a change in psychotherapy practices. Psychoanalytic treatment faces the challenge of reinstalling the channels of psychic communication within a new, virtual setting. This article describes particular aspects of the online care of a melancholic patient at risk of suicide and has been fictionalized for the sake of discretion. It reflects Freud's ideas in "Mourning and melancholy" and Sandor Ferenczi's approach to the management of transference in order to show the possibility of transforming psychic pain into a structuring experience through the migration of images into the world of language.

La pandemia actual ha obligado a las personas a enfrentar el horror de la finitud, ha impuesto el aislamiento social y ha requerido un cambio en las prácticas de psicoterapia. El tratamiento psicoanalítico se enfrenta al desafío de reinstalar los canales de comunicación psíquica en un nuevo escenario virtual. Este artículo describe aspectos particulares de la atención online de un paciente melancólico en riesgo de suicidio y se ha convertido en ficción por motivos de discreción. Refleja las ideas de Freud en "Duelo y melancolía" y el enfoque de Sandor Ferenczi sobre la gestión de la transferencia para mostrar la posibilidad de transformar el dolor psíquico en una experiencia estructurante a través de la migración de imágenes al mundo del lenguaje.

La pandémie actuelle a contraint les gens à affronter l'horreur de la finitude, imposé l'isolement social et le changement des pratiques de psychothérapie. C'est pourquoi la clinique psychanalytique est confrontée au défi de réinstaller les canaux de communication psychique dans un nouveau cadre virtuel. Cet article décrit des aspects particuliers des soins en ligne d'un patient mélancolique à risque de suicide et a été romancé par souci de discrétion. Son objectif est de montrer, à la lumière des idées de Freud dans « Deuil et mélancolie ¼ et celles de Sandor Ferenczi concernant la gestion du transfert, la possibilité de transformer la douleur psychique en une expérience structurante vers le monde du langage, au moyen de la migration des images.

Intervenção nas relações iniciais em tempos de pandemia: relato de experiência diante das possibilidades da clínica online / Precocious intervention in a time of pandemic: experience report on the possibilities of online clinic / Intervención temprana en tiempos de pandemia: relato de una experiencia frente a las posibilidades de la clínica online / Intervention dans les relations initiales en temps de pandémie: récit d'expérience face aux possibilités de la clinique en ligne

RESUMO Diante de um cenário em que o distanciamento social se tornou imperativo de ordem e saúde, as atividades virtuais passaram a ser priorizadas. O cuidado passa a ocupar os discursos e ações, tornando assim essencial que conheçamos novos dispositivos capazes de oferecer continência e sustentação, para dar continuidade a nossa clínica. Em especial na clínica com bebês e crianças pequenas, essa questão se amplifica por seu caráter preventivo e constitutivo. Ela deve ser um direito garantido que não pode esperar. Trata-se de um relato de experiência de intervenção nas relações iniciais da primeiríssima infância, realizada durante a pandemia de covid-19, à luz da psicanálise. Serão apresentadas vinhetas de um atendimento presencial e sua continuidade online, a fim de elucidar as possibilidades clínicas desse trabalho não presencial, mas nem por isso remoto.

ABSTRACT Facing a scenario in which social distance became imperative for discipline and health, virtual activities started to be prioritized. Care started to occupy discourses and actions, thus making it essential that we know new devices capable of offering continence and support, to continue our clinic. Especially the clinic with babies and young children, this issue is amplified by its preventive and constitutive aspect. It must be a right to be guaranteed and it cannot wait. This is an account of the experience of intervention in the early relationships of very early childhood, carried out during the pandemic of covid-19, in the light of psychoanalysis. Vignettes of face-to-face assistance and their online continuity will be presented in order to elucidate the clinical possibilities of this non-face-to-face, but not so remote work.

RESUMEN Frente a un escenario donde el distanciamiento social se tornó un imperativo de orden y salud, pasaron a ser prioridad las actividades virtuales. El cuidado pasa a ocupar los discursos y guiar las acciones, haciendo, de esta forma, esencial, que conozcamos nuevos dispositivos capaces de ofrecer fortaleza y sustentabilidad para dar continuidad a nuestra clínica. Esta cuestión se amplifica especialmente en la clínica con bebés y niños, dado su carácter preventivo y constitutivo. La misma es un derecho que debe ser garantizado y no puede esperar. Se trata de un relato de una experiencia de intervención en el vínculo temprano en la primerísima infancia, realizada durante la pandemia de la covid-19, a la luz del psicoanálisis. Serán presentadas viñetas de una sesión presencial y su continuidad online, con el objetivo de dilucidar las posibilidades clínicas de este trabajo no presencial, pero, no por eso, remoto.

RÉSUMÉ Face à un scénario où la distanciation sociale est devenue un impératif d'ordre et de santé, les activités virtuelles sont désormais priorisées. Les soins commencent à occuper les discours et les actions, rendant ainsi essentiel la connaissance de nouveaux dispositifs capables d'offrir continence et soutien, pour assurer la continuité de notre clinique. Dans la clinique des bébés et des jeunes enfants, en particulier, cette question s'amplifie en raison de son caractère préventif et constitutif. Cela doit être un droit à garantir qui ne peut pas attendre. Il s'agit ici d'un compte rendu d'une expérience d'intervention dans les relations initiales de la plus petite enfance, menée pendant la pandémie du covid-19, à la lumière de la psychanalyse. On présentera des vignettes d'un service en face-à-face et de sa continuité en ligne, afin d'élucider les possibilités cliniques de ce travail non pas en présence, mais ni pour autant distant.